Botulinum toxin A in the treatment of spasticity: Functional implications and patient selection

Objective: To explore the range of functional indications and benefit of botulinum toxin A (BTA) in spastic patients. Design: Case report of a series of patients selected for BTA treatment. Clinical information was collected in a prospective fashion on each patient. Setting: Freestanding acute rehabilitation hospital. Patients: 39 consecutive patients with 40 limbs with acquired spasticity. Intervention: All 39 patients received BTA injections into muscles targeted for treatment based on functional indications. Main Outcome Measures: Objective evaluation of outcome was measured by Ashworth Scale, goniometry, ambulation score, and brace wear scale. Subjective measures included patient self report of improvement and pain relief. Results: Mean BTA dose per limb was 180 units, mean number of muscles injected per limb was 2. Twenty-nine patients had subjective and/or objective improvement with treatment. Mean Ashworth Scale improvement was one point. Mean gain in active range of motion (AROM) was 17.0 degrees, and in passive range of motion (FROM) 18.4 degrees. Brace tolerance improved in 14 of 22 patients and pain relief occurred in 10 of 13 patients. There were no adverse effects, and there was no difference in duration of effect compared to dystonia patients. Conclusion: BTA is a useful intervention in the treatment of spasticity, with the majority of patients demonstrating improvement on objective measures of tone and function, and reporting improvement on subjective measures. Careful patient selection will maximize functional benefit. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.